Healthcare Provider Details

I. General information

NPI: 1275206138
Provider Name (Legal Business Name): DRIVEN GOLF PERFORMANCE AND SPORTS PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 MARY CT
EXETER CA
93221-2373
US

IV. Provider business mailing address

1470 MARY CT
EXETER CA
93221-2373
US

V. Phone/Fax

Practice location:
  • Phone: 559-920-5306
  • Fax: 559-471-3727
Mailing address:
  • Phone: 559-920-5306
  • Fax: 559-471-3727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH SAMUEL TERRILL
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 559-920-5306